The Basic of Health Insurance

The Basics

Health insurance, in this modern world of cancer,
heart disease, AIDS, diabetes, asthma, ageing and
other diseases and afflictions, it is essential to
have some sort of health insurance.

There are many levels of health insurance coverage
available; unfortunately, like most things in life,
you get what you pay for, and good coverage can be
very expensive.

The two most common terms in referring to health
insurance are premium, which is the amount paid for
the insurance, and deductible, which is your
out-of-pocket expense before the insurance pays your
provider.

For instance, you might pay $300 premium per month for
family coverage, and your deductible might be $250 per
person, which means if you fell and broke your ankle
and went to the hospital emergency room, you would be
required to pay the first $250 of the bill.

You can purchase very basic catastrophic coverage,
which would carry a very high deductible and the
premium would be less than comprehensive coverage
which would have a higher premium and lower
deductible.

It pays to invest the time to investigate various
insurance options, taking into consideration your age,
your general health and the health of your family
members.

Your employer may offer group health insurance, which
is most likely the least expensive option for you, and
usually the premium is deducted from your paycheck.

Health insurance is a calculated risk; can you afford
the premiums or are you willing to risk that you would
pay less out of pocket for medical expenses in a year
than the premiums would cost? Consider carefully.

Stay Legal! Avoiding Insurance Fraud

Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not understand what health insurance fraud entails, though. With reports estimating health insurance fraud is a $30 billion to over $100 billion industry per year, the topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and its consequences. By doing so, you are more able to recognize and fight fraud. 

Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Essentially this means that you assert that you paid for certain medical procedures or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud is to conceal pre-existing conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may think that this is a small issue in comparison to your sister receiving treatment, it is actually very serious to your health insurance company and industry, and will result in fines and possible imprisonment if your are caught.

Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company's investigation. 

Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear - along with the money you have been paying in premiums.

The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember - it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.

Something Old, Sometime New: Insurance When You are Getting Married

Health insurance providers are not created equal. Before a couple is married, the option of sharing coverage is extremely unusual unless one of your insurers offers domestic partner insurance. As you become engaged, if you both have separate insurance it is important to talk about the both of you switching to the better plan once you are married. There are a few factors consider, which include deductibles, co-payments, and the benefits of each separate plan. Marriage is a big step, and it can be done with ease if the two of you settle important decisions such as your health insurance plan before you take the big leap.

Your deductible is the amount you must pay each year to start your policy. Once this payment is made you will be responsible for whatever amount of co-payment your insurance company requires for you to pay for the health expenses that are covered in your particular policy. The amount of co-payments that you will be responsible for is established at the time you agree to your health insurance policy. It is going to be a certain percentage of health expenses; for instance, you pay 10% while your insurer will be paying the other 90%. You and your fiancé should compare both of your plans and figure out which deductible and co-payment plan seems most appropriate for the two of you. 

Married couples are usually eligible for certain benefits that unmarried couples are not. Being insured separately by the health care provider sponsored by your employers may no longer be the most beneficial option for you. If you or your fiancé has insurance, and the other does not, once the two of you are married they can be added to the other partner's plan. Cost of adding an additional person is definitely something that should be examined. You should not be required to pay more for adding a spouse or even a child in the future because most plans are offered to immediate family at no extra cost. The best way to compare policies is to estimate a yearly amount of normal health expenses, emergencies, co-payments, and deductibles. Whichever plan has the lowest cost to you will almost always be the best choice.

In addition to sharing health insurance with your new spouse, you may also want to consider switching the rest of your insurance plans, such as the policies you have for your separate automobiles. This is because most companies will give you a discount on having more than one vehicle insured. You may also be interested in finding a company that can insure you home, automobile, and health in one place. If you carry more than one policy with a company, they will also usually give you some sort of discount on them. It is important to sit down and discuss insurance with your fiancé because the two of you could be saving money and stress by figuring out what decision is best before the time comes.

Say Cheese: Dental Benefits

Dental insurance is often an afterthought when obtaining health insurance for a number of reasons. Some people may simply dislike the dentist and use the lack of dental insurance as a reason to not visit the dentist; others may feel that dental insurance is not worth the added cost to their monthly health insurance premium. Still others may simply feel that their teeth are in good shape and there is little need to spend the extra money to cover a part of their body that does not currently have any problems. Nevertheless, dental insurance is important because of several benefits.

When people think of the cost of dental work or procedures, they often think of costly bills. Even simple procedures like getting your wisdom teeth removed can average in the hundreds of dollars per tooth! However, one obvious benefit to dental insurance is the coverage of simple but costly dental procedures such as getting a tooth removed. In the end, the slight increase in a monthly premium may be worth it to avoid a high dental bill. Moreover, dental insurance also helps financially if a dental emergency develops. Perhaps you are in need of a root canal or dental implants - both extremely costly procedures that you often do not anticipate. Dental insurance will most likely cover a portion, if not all of these expensive procedures.

Also, while many feel that brushing and flossing daily is all the dental care they need this is simply not true - even for young, healthy adults. Dental disease is common and can affect your body in a number of ways. For instance, some dental diseases left untreated can lead to more serious medical issues such as kidney infections or even diabetes. Most people do now know of the connection between dental diseases and other illnesses. Thus, having dental insurance that covers routine visits to the dentist, which can help uncover dental diseases early, is extremely important. Dental insurance is designed to encourage preventative care, because spotting dental diseases or dental problems early reduces the overall cost of treatment. 

Dental insurance may seem like just another gimmick to get a few more dollars out of you, but it is essential for your health. Your regular health insurance plan, whether it is through your employer as a group plan or an individual plan, should offer you the option of buying dental insurance coverage, and you should consider this piece of the plan thoroughly when purchasing health insurance.

Protection during the Golden Years: Health Insurance and Retirement

Health insurance for retirees or senior citizens can be confusing, especially with so many options and requirements. However, health insurance is crucial for retirees. As you grow older, your health obviously becomes more of an issue; you may visit the doctor more, need to fill more prescriptions, or even receive in-home care. Before you retire, prepare for health insurance to ensure that you receive the best benefits.

The first step in planning your health insurance coverage in your retirement is to see if your employer offers insurance coverage after you retire. If the company does, you should certainly consider it. Look at the plan, the deductible, and the coverage. Many near-retirees believe that Medicare will cover their medical payments, but this is not always the case. With this sort of coverage, you will most likely receive better health care but at a more expensive cost. As a retiree, you will certainly have a health insurance budget to maintain, and you will have to decide if the cost of your employer's insurance is too expensive.

If your employer does not offer coverage, Medicare will be an important and integral part of your health insurance if you are 65 years of age or older. Medicare works like traditional health insurance plans in that you have been contributing a small portion of every paycheck you earn into this plan. Once Medicare begins, you will make co-payments for office visits or treatment. Medicare will also cover the expense of certain medical equipment or needs. 

However, Medicare did not cover a number of items that are typical of health insurance. The government recently updated Medicare and divided it into three parts: Part A, B, and C. Part A covers hospital care, such as home health care, hospital stays, and hospice care. This part does not require a premium. Part B covers the more routine medical expenses, such as office visits and laboratory tests, while Part C enrolls you into a fee-for-service or managed care plan that reduces your out-of-pocket costs. Despite these different options, Medicare restricts your coverage by not covering certain kinds of care or illnesses and diseases. Thus, there is also Medigap coverage, which helps fill in the gaps in health insurance that Medicare leaves. Medigap coverage differs from state to state and has different payments.

Beyond Medicare and Medigap, there are also long-term care insurance plans that you can buy. You often see these plans advertised on the television at very low prices. These plans can help cover the costs of a nursing home or home health care. With so many different options and limitations, if you are retiring soon, you should take a look at your budget and what you can afford as well as what sort of coverage you feel you will need.

Prescription Insurance Policies

Some health insurance policies do not provide for
prescription coverage and a separate policy must be
purchased for prescription medications.

This is an area where it pays to do some homework and
research and find the best policy for you.

Prescription coverage insurance is not a necessity;
like health insurance coverage, it is a calculated
risk, although the risk is not as high.

Usually you can buy prescription insurance at any
time, so if the doctor determines that you need an
expensive maintenance drug, you may opt in at that
time.

It is important to know that if you presently have
prescription insurance you can usually only change it
at a specific time of the year, although you can add
new prescriptions, you can’t change plans.

The person who seldom takes prescription medications
probably does not need prescription insurance;
however, a person who takes maintenance drugs for high
blood pressure, diabetes, depression, heart disease or
immune disorders most likely needs insurance against
the high costs of drugs.

Prescription insurance policies usually have "tiers",
which usually means that a generic drug is at a low or
no co-pay, a tier 2 level may be the brand name
genuine, and a tier 3 may be a brand new expensive
drug that the co-pay could be a set high-percentage of
the cost.

In choosing prescription insurance, you should first
list the prescriptions that you take and the retail
amount of them. If you chose not to purchase
insurance, this would be your monthly cost.

Find out from the provider what the monthly premium
for you would be, then what the prescription co-pay
amount would be and add these two figures together.
Which is the less expensive alternative?

Medicare

Medicare is a governmental program which provides
medical insurance coverage for retired persons over
age 65 or for others who meet certain medical
conditions, such as having a disability.

Medicare was signed into legislation in 1965 as an
amendment to the Social Security program and is
administered by the Center for Medicare and Medicaid
Services (CMS) under the Department of Human Services.

Medicare provides medical insurance coverage for over
43 million Americans, many of whom would have no
medical insurance. While not perfect, the Medicare
program offers these millions of people relatively low
cost basic insurance, but not much in the way of
preventative care. For instance, Medicare does not pay
for an annual physical, vision care or dental care.

Medicare is paid for through payroll tax deductions
(FICA) equal to 2.9% of wages; the employee pays half
and the employer pays half.

There are four "parts" to Medicare: Part A is hospital
coverage, Part B is medical insurance, Part C is
supplemental coverage and Part D is prescription
insurance. Parts C and D are at an added cost and are
not required. Neither Part A nor B pays 100% of
medical costs; there is usually a premium, co-pay and
a deductible. Some low-income people quality for
Medicaid, which assists in paying part of or all of
the out-of-pocket costs.

Because more people are retiring and become eligible
for Medicare at a faster rate than people are paying
into the system, it has been predicted that the system
will run out of money by 2018. Health care costs have
risen dramatically, which adds to the financial woes
of Medicare and the system has bee plagued by fraud
over the years.

No one seems to have a viable solution to save this
system that saves many people throughout the country.